Hysterectomy (surgical removal of the uterus) is performed more often in the United States than in any other country. Some studies suggest it may be performed more often than is necessary. If a hysterectomy has been recommended for you, be sure to ask your health care provider about other treatments and surgical options so you are fully informed about the immediate and long-term risks and benefits of each choice before making your decision.

In considering a hysterectomy, you may wish to get a second opinion and discuss your condition with another health care professional. Getting a second opinion doesn't mean you are being disloyal to your primary care provider. In fact, many health insurance plans require and pay for a second opinion before any major surgery and will be able to give you names of appropriate providers in your area. It is best to request a provider who is board certified in obstetrics and gynecology.

Things to think about

• In most cases, hysterectomy is elective surgery.
• Hysterectomy surgery generally requires a stay of 1 to 4 days in the hospital with 4 to 6 weeks of recovery.
• Hysterectomy is not reversible.
• Symptoms like pelvic pain or unusual bleeding may not necessarily be related to the uterus. An accurate diagnosis will help you determine the potential benefits and risks of a hysterectomy.
• You will no longer have periods and cannot become pregnant after a hysterectomy. If pregnancy is desired, hysterectomy is not an appropriate treatment option for conditions such as uterine fibroids, endometriosis, or pelvic organ prolapse. Talk with your doctor about other treatments.
• Hysterectomy may be the only option for cancer of the pelvic organs.
• If both ovaries are removed (bilateral oophorectomy) from a premenopausal woman, estrogen levels immediately decline, causing menopause to abruptly occur. The symptoms of menopause include hot flashes, night sweats, insomnia, fatigue, depression and vaginal dryness along with an increased risk of osteoporosis and heart disease. Natural estrogen replacement is an option to consider if surgery will include a bilateral oophorectomy.
• Even if the ovaries are retained you may experience premature ovarian failure due to the ovaries stopping hormone production. This loss of ovarian function can occur in as few as one to two years after the hysterectomy.

Alternatives

Some conditions including fibroids, endometriosis and uterine prolapse, offer self-care and surgical alternative treatments that may be tried before deciding on a hysterectomy.

• Many conditions for which hysterectomy is recommended may diminish as a woman enters menopause, however, use of hormone therapy could continue to support those conditions.
• Self-care measures may improve some conditions for which hysterectomy is recommended simply by easing pressure on pelvic muscles or increasing pelvic muscles. Self-care measures include losing weight, emptying the bladder frequently, avoiding constipation, avoiding caffeine and alcohol that increase the risk of urinary leakage, and Kegel exercises, (pelvic floor exercises).
• Supporting healthy hormone balance through exercise and a healthy diet may also help improve some conditions. Natural progesterone cream, vaginal moisturizer, and specially formulated vitamin supplements such as ProCycle^® PMS, and ProCycle^® Gold are available without a prescription and can also help support healthy hormone balance.
• Alternatives include non-surgical vaginal pessary to support pelvic organs, endometrial ablation, myomecotmy to remove fibroids, uterine fibroid embolization, hysteroscopy and laparoscopy for treatment of a number of gynecological conditions.
• There are a number of drug therapies for different conditions. Talk with your health care provider.
• Balanced thyroid levels along with balanced estrogen and progesterone levels may help reduce heavy bleeding without surgery.

Important Questions to Ask Your Health Care Provider

Asking your health care provider the following questions will help you decide if hysterectomy is right for you. Source: New York State Department of Health.

• Why do I need to have a hysterectomy?
• What organ or organs will be removed and why?
• Will my ovaries be left in place? If not, why?
• Will my cervix be removed? If so, why?
• Are there alternatives for me besides a hysterectomy?
• What are the advantages, risks, benefits of each?
• What will be the physical effects of a hysterectomy?
• Are these permanent?
• What will happen to my figure, my weight, my breasts?
• How will it affect my sex life?
• Will I experience menopause (change of life)? Can the symptoms of menopause be treated? What are the risks and benefits of such treatment?
• Will the operation be a vaginal or abdominal hysterectomy? And why?
• What can I expect in the hospital? pre-operative procedures? length of stay? anesthesia? infection? transfusion? urinary catheter?
• What kind of care will I need after my hysterectomy?
• How should I prepare for coming home from the hospital?
• How soon can I go back to work? Try heavy housework?
• When can I resume sexual activity?